- guardian.co.uk, Tuesday August 7 2007 00.08 BST
Your report on GPs pay and hours (August 1) highlights the problem with their status as self-employed contractors to the NHS. Much of the work (eg immunisation) on which these pay hikes were based, in a poorly negotiated deal, was already being carried out by other health professionals. GPs can now opt out of out-of-hours provision placing even more burdens on other health staff. Yet many of these same GPs are denying their staff the terms of their own national pay agreement, saying they have received no funding for this. They have, but it appears GPs believe it is better spent rewarding themselves.
Likewise, while GPs are reducing their own hours as commissioners of services, they are demanding from services such as podiatry and physiotherapy a greater intensity of work, which will lead to longer hours being worked. Health service staff's contracted hours are already longer than the average hours being worked by GPs. Given the opportunity, many GPs act like any other "boss": pay hikes for themselves and greater exploitation for their workers. Loth as I am to agree with the CBI, wouldn't we get better value and better service provision if we moved GPs on to employed status?
Colin Adkins
Wrexham, Clywd
How exactly are GPs providing a "higher quality of care" under the new contract? Weighing an inability to see a GP after 6pm and at weekends against reports of inflated salaries and shorter working hours, many patients will not draw such a conclusion. At what point will GPs price themselves out of the market for the limited roles they perform?
Paul Johnson
Nottingham
Proof that the average length of time GPs spend with patients has increased is a welcome development. The extra minutes we are spending in conversations with health professionals are vital to the success of a 21st century health service. As the Wanless review of the NHS concluded, our health service must work in partnership with patients - not merely administer to them. And this can only be achieved through building strong, meaningful relationships.
But successful relationships are based on reciprocity and continuity. And as the importance of primary care continues to increase, GPs will find it difficult to justify a service that is perceived to operate more to their convenience than to the public - especially in the light of salaries five times the national average and a working week shorter than the national average of 42.2 hours.
The positives of a strong relationship with a family doctor are immediately negated if you can't see them. And more important than the time lost at work through attending doctors appointments are the consultations missed or delayed due to work commitments. If GP services aren't adaptable, early intervention and prevention will be hampered. A GP's legitimate need for a work-life balance must fit with the need for flexible and responsive primary care.
Faizal Farook
Public services researcher, Demos
I sympathise with the young junior doctors disrupted by this year's job applications process (Report, August 2) since there have obviously been errors in implementing it. But Dr Majjiga's complaints seem out of proportion: he had to wait for a late running interview; he had to claim back travel expenses; and his wife has to move her job. Alas, these dilemmas and problems face thousands of people every week. Doctors must have been very cushioned from the real world if this sort of stress is news to them.
Linda Fairbrother
Cambridge
Jane Caplan, professor of history, asks: "If I see fewer students and stop working at weekends, can I have my salary doubled, please." If you saw fewer students, professor, would anyone care? GPs deliver a frontline medical service in a high-pressure environment. Jealousy should have no place in this debate.
Denis Jackson
London
If I see no patients for 12 weeks in the summer and for four weeks at Christmas and Easter, I'll gladly halve my salary.
Dr Julia Purr
Cambridge
